| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,585 |
768 |
$231K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,725 |
911 |
$155K |
| D1120 |
Prophylaxis - child |
2,582 |
2,528 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,590 |
1,007 |
$101K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,130 |
721 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,240 |
3,170 |
$89K |
| D1351 |
Sealant - per tooth |
1,390 |
494 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,443 |
835 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,851 |
2,787 |
$69K |
| D1110 |
Prophylaxis - adult |
1,137 |
1,117 |
$50K |
| D0274 |
Bitewings - four radiographic images |
3,057 |
2,991 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
183 |
149 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,682 |
1,644 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
5,182 |
5,021 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,437 |
1,370 |
$27K |
| D0330 |
Panoramic radiographic image |
973 |
944 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,427 |
3,835 |
$19K |
| D1206 |
Topical application of fluoride varnish |
643 |
631 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
166 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
783 |
769 |
$12K |
| D2335 |
|
73 |
58 |
$7K |
| D2332 |
|
61 |
46 |
$6K |
| D2394 |
|
69 |
58 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
24 |
24 |
$5K |
| D9110 |
|
81 |
79 |
$4K |
| D0272 |
Bitewings - two radiographic images |
303 |
292 |
$3K |
| D4910 |
|
38 |
38 |
$3K |
| D2950 |
|
30 |
26 |
$2K |
| D9310 |
|
109 |
109 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$866.70 |
| D2330 |
|
12 |
12 |
$730.52 |
| D1999 |
|
15 |
15 |
$0.00 |